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A Systematic Critical Appraisal of Clinical Practice Guidelines in Heart Failure Using the AGREE II Tool

Andrew Sephien1, Denisse Camille Dayto2, Tea Reljic3

  • 1Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplantation, University of Alabama at Birmingham, Birmingham, Alabama.

The American Journal of Cardiology
|July 14, 2023
PubMed

Insights

This systematic review critically appraised heart failure clinical practice guidelines (CPGs) using AGREE II. While clarity and scope were high, applicability and rigor require improvement for better patient care.

Area of Science:

  • Cardiology
  • Clinical Practice Guidelines
  • Health Services Research

Background:

  • Multiple clinical practice guidelines (CPGs) exist for heart failure management to optimize patient outcomes.
  • A critical appraisal of the methodological quality of these heart failure guidelines has been lacking.

Approach:

  • A systematic review was conducted to assess the methodological quality of heart failure CPGs published between January 1, 2021, and September 8, 2022.
  • The Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument was used to evaluate 6 included CPGs.
  • CPGs were sourced from North America, Asia, Europe, and South America.

Key Points:

  • Median AGREE II scores varied significantly across domains: 100% for Scope and Purpose, Clarity of Presentation, and Editorial Independence.
  • Scores for Stakeholder Involvement and Rigor of Development were 71%, while Applicability scored 43%.
  • Overall assessment scores averaged 64%.

Conclusions:

  • Current heart failure CPGs demonstrate high quality in scope, clarity, and independence but show variability in stakeholder involvement, rigor, and applicability.
  • Standardized approaches and the AGREE II tool can enhance the methodological rigor, reporting, and practical application of future CPGs.
  • Improvements are needed to ensure CPGs effectively translate to improved patient morbidity and mortality in heart failure management.

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